8/14/13 – Bar Harbor, Maine
Bev had seemed a little distracted for some time. I didn’t think much about it but she had a few behavior changes that I could not explain. After all that’s what I do.
So I decided to take her to the local Emergency Room and see if they could figure out why she was not herself.
I found the local hospital and soon was in a room in the ED after not too long a wait. In a few minutes there was a knock on the door. It was followed by the entrance of a young doctor (they all seem young to me) and his nurse. The nurse seemed a little older and more experienced. I wondered if she was there to help the Dr. with his Dx.
“What seems to be the problem.” The young Dr. asked with a somewhat forced smile.
I try not to mention my MD life when I travel. It sometimes sets the wrong expectation.
“Well, Dr. lately Bev has not been herself.” I tired to sound like a lay person. “She passed up the opportunity to go shopping. That’s when I knew she wasn’t well.”
That’s when I got my first strange look.
“Is that it?” He queried.
“Well, no there’s more.’ I answered a little defensively. “She hates cold water but lately she has wanted to go swimming in the ocean.” He raised an eyebrow. I had his interest.
Picture Bev sitting quietly in the room.
“Why yes.” Now I thought I had his interest . “She normally insists on hot showers and she is avoiding hot water all together.”
The Dr. turned to his nurse and they nodded to each other just perceptively.
“Has she been touching her thumb with her first two fingers?” asked the Dr.
“Why yes she has.” I said with surprise. “I didn’t know what to make of that.”
Has she been crawling around aimlessly on the floor from time to time?”
I nodded my head. How did he know?
The young Dr. smiled and turned knowingly to his nurse. This time she nodded her head.
“Sounds like ALT to me.” He remarked. The nurses headed bobbed again.
I didn’t want to sound dumb but couldn’t resist asking. “ALT?”
“Acute lobster toxicity syndrome.”
“Is it serious?” I asked.
“How many lobsters has she been eating a day?”
“Two every day.”
“And how many lobster rolls?
“Three or four at least.”
“Does she have an aversion to melted butter?”
“Oddly enough, she does”
“Pretty classic. We see it around here all the time.”
“I’ve never seen it.”
“Where do you live?
“That explains that.” He remarked casually.
There was a knock on the door and a tech handed a sheet of paper to the nurse. She looked at it and smiled and handed it to the Dr. He glanced at it.
“When she came in we drew some blood. Her SLL is 800.”
Enough of the acronyms. “SLL?”
“Serum lobster level.” The Dr. responded as he started typing on his computer.
“What’s normal?” I queried.
“Depends where you live. Probably zero in Colorado. Around here we go up to 25 often.”
Back to the computer.
“Treatment?” I felt like I was interrupting his computer time.
“Well, I don’t think we need to use the Anti Lobster Toxin as yet. Its pretty expensive. She seems pretty healthy and should clear. We don’t want a rapid withdrawal so limit her at first to 3 lobster rolls per day and taper her off after about a week. My nurse will give you a couple of big rubber bands in case that thing with the fingers becomes a problem before she clears. Good luck.”
“Thank you doctor.” I manage to mumble humbly. “How could I have missed it.” I thought to myself. I guess you learn something new every day.